Efficacy of Cancer Support Programs: A Social Comparison Theory Analysis

描述（由申请人提供）团体心理社会计划可以改善情绪，增加对前列腺癌患者的支持。一些研究显示，对经历痛苦的患者有益处，而对轻度/无痛苦的患者没有益处，然而，无论是否证明需要干预，患者通常都会入选试验。只包括那些有痛苦的人的项目可能会更好地满足病人的需求。研究人员有不同的意见进行程序与同质群体的困扰患者，因为非困扰患者可能需要模型适应性应对。尽管包括社会比较理论（SCT）在内的经过充分验证的理论模型支持这一观点，但还没有专门设计或充分有力的研究来研究苦恼患者是否从非苦恼患者的存在中受益，以及非苦恼患者是否从参与中受益。根据SCT的说法，癌症患者更喜欢与不幸的人进行自我评估，以增强自尊和管理情绪，同时，更喜欢从更幸运的人那里获取信息并与他们建立联系，以学习适应性应对。一个异质性的支持计划（痛苦和非痛苦的患者）为痛苦的患者提供最大的机会，首选的社会比较;一个同质性的计划（仅痛苦的患者）没有。对于非痛苦的患者，首选社会比较的机会可能有限，这可能对心理社会功能和生活质量（QOL）没有甚至产生负面影响。本研究的目的是检查组的组成对前列腺癌患者的心理社会计划的有效性的影响，并评估是否更有效的方案时，实施在一个异质性与同质性组的困扰患者。还将检查非痛苦患者的异质组的疗效。在更大规模的试验解决这些问题之前，这项可行性研究将在90名前列腺癌患者（60名痛苦和30名非痛苦）中进行。痛苦的患者将被随机分配到异质组中的3个月心理社会计划或同质组中的相同计划。其目的是：1a）收集可行性和过程评估数据; 1b）估计抑郁患者的百分比以及社会比较取向高和低的百分比; 2a）获得两组抑郁患者在3个月时心理功能和QOL的效应量估计值; 2b）估计两组抑郁患者在3个月时对假设SCT介体的效应; 2c）探索异质组中非苦恼患者的苦恼变化;以及2d）探索苦恼和非苦恼患者在社会比较测量上的差异，并检查参与团体计划后这些测量的变化。 公共卫生相关性：这项研究可能表明，以满足患者的需求，经历心理困扰，团体可能是最有效的，当他们包括成员经历混合的痛苦水平。如果这些异质性的项目被证明是有害的，或者对没有痛苦的患者没有任何好处，那么他们被转介到支持团体时就会出现伦理问题。研究结果可能建议修改目前的研究和临床实践，其中非痛苦的患者仍然作为参与者，但经过适当的培训，以最大限度地提高痛苦患者的利益，并最大限度地减少对自己的负面影响。

DESCRIPTION (provided by applicant) Group psychosocial programs may improve mood and increase support for prostate cancer patients. Some studies show benefits for patients experiencing distress and no benefit for those with low/no distress, yet patients are typically enrolled in trials regardless of any demonstrated need for an intervention. Programs including only those with distress may better address patient needs. Researchers have varying opinions about conducting programs with homogeneous groups of distressed patients since non-distressed patients may be needed to model adaptive coping. Though well-validated theoretical models including Social Comparison Theory (SCT) support this view, no research has been specifically designed or adequately powered to examine whether distressed patients benefit from the presence of non-distressed patients and whether non-distressed patients benefit from participation. According to SCT, cancer patients prefer evaluating themselves against less fortunate others to increase self-esteem and manage mood, and concurrently, prefer obtaining information from and affiliating with more fortunate others to learn adaptive coping. A heterogeneous support program (distressed and non-distressed patients) provides distressed patients maximal opportunity for preferred social comparisons; a homogeneous program (distressed patients only) does not. For non-distressed patients, opportunities for preferred social comparisons may be limited, creating the possibility for no or even negative effects on psychosocial functioning and quality of life (QOL). The purpose of this research is to examine the effect of group composition on psychosocial program efficacy for prostate cancer patients and evaluate whether programs are more efficacious for distressed patients when implemented in a heterogeneous versus a homogeneous group. The efficacy of the heterogeneous group for non-distressed patients also will be examined. Prior to the larger trial powered to address these questions, this feasibility study will be conducted with 90 prostate cancer patients (60 distressed and 30 non-distressed). Distressed patients will be randomized to a 3-month psychosocial program in a heterogeneous group or the same program in a homogeneous group. The aims are to: 1a) collect feasibility and process evaluation data; 1b) develop estimates of the percentages of distressed patients and of those high and low in social comparison orientation; 2a) obtain estimates of the effect sizes for distressed patients in both groups on psychological functioning and QOL at 3 months; 2b) estimate the effects on distressed patients in both groups on hypothesized SCT-mediators at 3 months; 2c) explore changes in distress in the non-distressed patients in the heterogeneous group; and 2d) explore differences in distressed and non-distressed patients on measures of social comparison and examine changes in these measures for both following participation in the group program. PUBLIC HEALTH RELEVANCE: This research may indicate that to address the needs of patients experiencing psychosocial distress, groups may be most efficacious when they comprise members experiencing mixed distress levels. If these heterogeneous programs prove harmful or offer no benefit to non-distressed patients, ethical issues emerge regarding their referral to support groups. Findings may suggest a modification to current research and clinical practice wherein non-distressed patients remain as participants, yet are properly trained to maximize benefit for distressed patients and minimize negative consequences for themselves.